Journal of Urban Health

, Volume 92, Issue 2, pp 379–386 | Cite as

Comparison of Risk-Based Hepatitis C Screening and the True Seroprevalence in an Urban Prison System

  • Danica E. KuncioEmail author
  • E. Claire Newbern
  • Marcelo H. Fernandez-Viña
  • Bruce Herdman
  • Caroline C. Johnson
  • Kendra M. Viner


Hepatitis C virus (HCV) is the most common blood-borne infection in the USA, though seroprevalence is elevated in certain high-risk groups such as inmates. Correctional facility screening protocols vary from universal testing to opt-in risk-based testing. This project assessed the success of a risk-based HCV screening strategy in the Philadelphia Prison System (PPS) by comparing results from current testing practices during 2011–2012 (Risk-Based Screening Group) to a September 2012 blinded seroprevalence study (Philadelphia Department of Public Health (PDPH) Study Cohort). PPS processed 51,562 inmates in 2011–2012; 2,727 were identified as high-risk and screened for HCV, of whom 57 % tested HCV antibody positive. Twelve percent (n = 154) of the 1,289 inmates in the PDPH Study Cohort were anti-HCV positive. Inmates ≥30 years of age had higher rates of seropositivity in both groups. Since only 5.3 % of the prison population was included in the Risk-Based Screening Group, an additional 4,877 HCV-positive inmates are projected to have not been identified in 2011–2012. Gaps in case identification exist when risk-based testing is utilized by PPS. A more comprehensive screening model such as opt-out universal testing should be considered to identify HCV-positive inmates. Identification of these individuals is an important opportunity to aid underserved high-risk populations and to provide medical care and secondary prevention.


Hepatitis C virus Correctional health Testing strategies 



The authors would like to acknowledge the work of the PPS staff, specifically Reed Domer-Shank. In addition, the Philadelphia Public Health Laboratory staff made this project possible. Funding for this analysis was provided, in part, through the Centers for Disease Control and Prevention Cooperative Agreement for Addressing Syndemics Through Program Collaboration and Service Integration (5U38PS003152).


  1. 1.
    Armstrong GL, Wasley A, Simard EP, McQuillan GM, Kuhnert WL, Alter MJ. The prevalence of hepatitis C virus infection in the United States, 1999 through 2002. Ann Intern Med. 2006; 144(10): 705–714.CrossRefPubMedGoogle Scholar
  2. 2.
    Larney S, Mahowald MK, Scharff N, Flanigan TP, Beckwith CG, Zaller ND. Epidemiology of hepatitis C virus in Pennsylvania state prisons, 2004–2012: limitations of 1945–1965 birth cohort screening in correctional settings. Am J Public Health. 2014; 104(6): e69–74.CrossRefPubMedGoogle Scholar
  3. 3.
    Fox RK, Currie SL, Evans J, et al. Hepatitis C virus infection among prisoners in the California state correctional system. Clin Infect Dis. 2005; 41(2): 177–186.CrossRefPubMedGoogle Scholar
  4. 4.
    Macalino GE, Vlahov D, Sanford-Colby S, et al. Prevalence and incidence of HIV, hepatitis B virus, and hepatitis C virus infections among males in Rhode Island prisons. Am J Public Health. 2004; 94(7): 1218–1223.CrossRefPubMedCentralPubMedGoogle Scholar
  5. 5.
    Gough E, Kempf MC, Graham L, et al. HIV and hepatitis B and C incidence rates in US correctional populations and high risk groups: a systematic review and meta-analysis. BMC Public Health. 2010; 10: 777.CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    Chak E, Talal AH, Sherman KE, Schiff ER, Saab S. Hepatitis C virus infection in USA: an estimate of true prevalence. Liver Int. 2011; 31(8): 1090–1101.CrossRefPubMedGoogle Scholar
  7. 7.
    Solomon L, Flynn C, Muck K, Vertefeuille J. Prevalence of HIV, syphilis, hepatitis B, and hepatitis C among entrants to Maryland correctional facilities. J Urban Health. 2004; 81(1): 25–37.CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Spradling PR, Rupp L, Moorman AC, et al. Hepatitis B and C virus infection among 1.2 million persons with access to care: factors associated with testing and infection prevalence. Clin Infect Dis. 2012; 55(8): 1047–1055.CrossRefPubMedGoogle Scholar
  9. 9.
    Fazel S, Baillargeon J. The health of prisoners. Lancet. 2011; 377(9769): 956–965.CrossRefPubMedGoogle Scholar
  10. 10.
    Tsang TH, Horowitz E, Vugia DJ. Transmission of hepatitis C through tattooing in a United States prison. Am J Gastroenterol. 2001; 96(4): 1304–1305.CrossRefPubMedGoogle Scholar
  11. 11.
    Denniston MM, Klevens RM, McQuillan GM, Jiles RB. Awareness of infection, knowledge of hepatitis C, and medical follow-up among individuals testing positive for hepatitis C: National Health and Nutrition Examination Survey 2001–2008. Hepatology. 2012; 55(6): 1652–1661.CrossRefPubMedGoogle Scholar
  12. 12.
    Wilper AP, Woolhandler S, Boyd JW, et al. The health and health care of US prisoners: results of a nationwide survey. Am J Public Health. 2009; 99(4): 666–672.CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Spaulding AS, Kim AY, Harzke AJ, et al. Impact of new therapeutics for hepatitis C virus infection in incarcerated populations. Top Antivir Med. 2013; 21(1): 27–35.PubMedCentralPubMedGoogle Scholar
  14. 14.
    Ghany MG, Strader DB, Thomas DL, Seeff LB. Diagnosis, management, and treatment of hepatitis C: an update. Hepatology. 2009; 49(4): 1335–1374.CrossRefPubMedGoogle Scholar
  15. 15.
    Prisons FBo. Clinical Practice Guidelines: Preventive Health Care. Washington, D.C. : Federal Bureau of Prisons April 2013.Google Scholar
  16. 16.
    Kim AY, Nagami EH, Birch CE, Bowen MJ, Lauer GM, McGovern BH. A simple strategy to identify acute hepatitis C virus infection among newly incarcerated injection drug users. Hepatology. 2013; 57(3): 944–952.CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    Macalino GE, Dhawan D, Rich JD. A missed opportunity: hepatitis C screening of prisoners. Am J Public Health. 2005; 95(10): 1739–1740.CrossRefPubMedCentralPubMedGoogle Scholar
  18. 18.
    Philadelphia Prison System Performance Report. In: System PP, ed. Philadelphia, PA; July 8, 2014.Google Scholar
  19. 19.
    Tohme RA, Xing J, Liao Y, Holmberg SD. Hepatitis C testing, infection, and linkage to care among racial and ethnic minorities in the United States, 2009–2010. Am J Public Health. 2013; 103(1): 112–119.CrossRefPubMedCentralPubMedGoogle Scholar
  20. 20.
    Hennessey KA, Kim AA, Griffin V, Collins NT, Weinbaum CM, Sabin K. Prevalence of infection with hepatitis B and C viruses and co-infection with HIV in three jails: a case for viral hepatitis prevention in jails in the United States. J Urban Health. 2009; 86(1): 93–105.CrossRefPubMedCentralPubMedGoogle Scholar
  21. 21.
    ABA. ABA Criminal justice standards on treatment of prisoners: American Bar Association; February 2010 2009.Google Scholar
  22. 22.
    Shah BB, Wong JB. The economics of hepatitis C virus. Clin Liver Dis. 2006; 10(4): 717–734.CrossRefPubMedGoogle Scholar
  23. 23.
    Nave RL. Baby boomers and the hepatitis C boom. Ann Emerg Med. 2013; 62(6): 19A–21A.CrossRefPubMedGoogle Scholar
  24. 24.
    USPSTF. Screening for hepatitis C virus infection in adults: final recommendation statement. 2013; Accessed March 18, 2014.
  25. 25.
    McNamara BC, Losikoff PT, Huguenin L, Macalino GE, Rich JD, Gregory SH. Increasing hepatitis C prevalence and associated risk behaviors among incarcerated young adults. J Urban Health. May 31 2013.Google Scholar
  26. 26.
    Klein SJ, Wright LN, Birkhead GS, et al. Promoting HCV treatment completion for prison inmates: New York State’s hepatitis C continuity program. Public Health Rep. 2007; 122(Suppl 2): 83–88.PubMedCentralPubMedGoogle Scholar

Copyright information

© The New York Academy of Medicine 2015

Authors and Affiliations

  • Danica E. Kuncio
    • 1
    Email author
  • E. Claire Newbern
    • 1
  • Marcelo H. Fernandez-Viña
    • 1
  • Bruce Herdman
    • 2
  • Caroline C. Johnson
    • 1
  • Kendra M. Viner
    • 1
  1. 1.Philadelphia Department of Public HealthDivision of Disease ControlPhiladelphiaUSA
  2. 2.Philadelphia Prison SystemPhiladelphiaUSA

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